Penis size and enlargement surgery

A lot of men ask for enlargement surgery. And a very few ask for reduction surgery. The latter is very rarely done – though in 2015, a Florida urologist reported that he had successfully reduced the penile size of a young man whose penis was the size and shape of an American football (as a result of complications of sickle cell anaemia).

Enlargement surgery is pretty uncommon, so most men who ask for it will be disappointed.

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Many men are obsessed with the size, and particularly the length, of their penises.

Women will probably find this incomprehensible, but there are actually numerous websites and blogs on which males discuss their penile length with each other and on which they advance ideas as to how it could be 'improved'.

Most of this concern about the length of the phallus is pretty pointless, since recent research has shown that the majority of females could not care less about the length of the partner's organ.

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However, some of them do say that, given the choice, they would prefer a thicker penis to a thin one.

Another development of recent years has been the gradual realisation that widely-published and accepted figures for average penile length were actually wrong.

These figures, which have appeared in textbooks, medical journals, magazines and newspapers for over 50 years, have now been shown to be somewhat exaggerated. And those false statistics have made quite a lot of men feel inadequate about their length – when in fact they had nothing to worry about at all.

How did these exaggerations occur?

Quite simply, it happened because virtually all research on penis length had been done by 'self-reporting'. In other words, men used to be invited to measure their own penises, and then send in the resulting figure to the researcher.

It seems likely that in many cases, the males 'gave themselves the benefit of the doubt' and submitted a measurement that was perhaps half an inch or so too long.

The famous Dr Alfred Kinsey, who brought out his major report on male sexuality in 1948, studied 3,500 men. But he obtained his figures for penile length by sending each subject a postcard, and asking for it to be returned with the erect length marked on it.

So he didn't examine or measure any of these guys at all. The result was that Kinsey mistakenly thought that the average man measured 6.2inches (15.75cms) in erect length. This figure was published again and again over the next half-century.

In fact, no large-scale objective measurement of penile length (with the readings being taken by independent medical personnel) occurred until 2001, when the now-famous Ansell study was carried out in Cancun, Mexico.

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The Ansell/Cancun study

Though the circumstances of the Ansell experiment may seem a little bizarre, the results which were obtained are very valuable.

What happened was that the manufacturers of LifeStyles condoms (Ansell Inc) knew that a large number of young (but over 18) American college men were taking a spring break in the well-known Mexican resort of Cancun.

The firm set up a group of tents, staffed by a doctor and four female nurses. Males were invited to enter these tents and have their erections measured by the nurses, who were gloved, working in pairs, and supervised by the doctor.

Not altogether surprisingly, over 400 guys volunteered for this experiment. But in the event, many of them simply could not manage an erection under those conditions.

However, the medical staff did finally manage to record the erect measurements of 300 men. Nothing like this had been done before.

What were their findings? In summary, they were:

the average erect penis length was only 5.88 inches (14.9cms)

the average erect girth (circumference at mid-shaft) was 4.97 inches (12.6cms)

the majority of men (59 per cent) had an erect length which fell in the range of 5.25 inches (13.3cms) to 6 inches (15.2cms)

only about one man in four had a penis length of 6 inches or more

only about 10 men out of the 300 had penises which measured 7 inches (17.8 cms) or more.

The King's College Hospital Study

In 2015, a psychiatrist at King's College Hospital, London, published a paper which was interpreted by the national and international press as meaning that the average man's penile length (when erect) is only 5.2 inches (13.2 cms).

In fact, this much-reported publication was merely a 'meta-analysis' (pooled study) of a lot of other papers which had been published in various countries over the last 25 years or so.

So really, at the moment it seems that the Cancun research is the most reliable we have.

As noted above, it appears to show that the average younger man has a penis that is 5.88 inches (14.9 cms) in length.

Anxiety about the penis

The above findings should help to reassure some of the many males who feel anxious about what they feel is their 'lack of length'.

For years sexologists and Agony Aunts have been inundated with letters and emails from anguished young men who think (for instance) that a penile length of 5.5 inches (13.97 cms) is terribly short. It is now clear that it's normal.

But almost all men, of whatever age, experience anxiety about the size or appearance of their penises at some time. For most males, these feelings will pass but, for others, they can be persistent and disabling – and lead to requests for surgery.

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A man's concern about his penis can lead to avoidance of sexual relationships, and even of sporting and other activities where other men might see him naked.

Such men are not only embarrassed by the apparent smallness of their penis, but also very often ashamed about their anxiety.

Problems with judging penis size

Men generally fall into two groups regarding their penis size and appearance.

Some men have a short, fat, rather elastic penis when flaccid that stretches and expands very considerably during erection.

Others have a long, impressive-looking flaccid penis that barely changes in size when erect, and simply becomes more rigid. Men in the first group who see men from the second group naked in the showers are likely to feel inadequate.

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Both groups are normal, just different.

Obesity and very thick growth of pubic hair may make the penis appear smaller.

Obese men develop a pad of fat in the pubic area and the flaccid penis becomes buried in it. Weight reduction will improve appearance, as will neatly trimming excessive pubic hair.

Very obese men might not be able to see their penis at all, because of their large and pendulous abdomen.

Men should also remember that the penis will always look shorter when you look down at it, compared with looking straight at their penis in a mirror or across the changing room at another man's penis. This is a simple optical illusion.

What is a normal penis?

When measuring penis size, it is important to distinguish between the respective sizes of the flaccid, stretched flaccid and erect penis.

Many men are concerned about the apparent size of their flaccid ('soft') penis, and worry that other men will laugh at them in the shower, or that sexual partners will ridicule them when they see them naked.

The flaccid penis varies considerably in size, ranging from less than 2 inches (5.1cms) to over 5 inches (12.7cms). The size of the flaccid penis does not determine the size of the erect penis.

Masters and Johnson (1966) found that the size of the erect penis ranges from 12.5 to 17.5cm (4.9 to 6.9 inches).

They also demonstrated that men with a smaller flaccid penis had a proportionally greater increase in size on erection.

What is an abnormally small penis?

No widely accepted definition of what is an abnormally small penis exists, but guidelines for selection of men for penis enlargement (penile augmentation surgery) recommend that only those with a flaccid length of less than 1.6 inches (4.1cms) ) or an erect length of less than 3 inches (7.6cms) should be considered for surgery.

Does penis size matter?

The answer to this question rather depends upon your perspective. If you believe that you have a small penis, it may matter very much to you, however unimportant the issue might seem to others.

Some men become quite obsessed by the size of their penis and will consider almost anything, including surgery, to enlarge it.

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Most of these men will have a penis that falls within the suggested normal size range, but that does not always make them feel normal or better about themselves.

Both they, and their doctors, should recognise that this is primarily a psychological problem, connected to physical and sexual self-image, rather than a physical handicap.

Researchers have repeatedly shown that penis size does not affect partner satisfaction during sexual intercourse.

Some men born with a severely shortened and malformed penis, even less than 2 inches (5.1cms) long when erect, enjoy very satisfactory sex with their partners.

Women are much more likely to be bemused by men's anxieties surrounding penis size, than amused by its actual dimensions.

Penis enlargement treatments

It should be said right away that 'do-it-yourself' treatments, which you buy via the internet or from a men's magazine, are most unlikely to do anything at all for you.

Treatments aimed at increasing penile length or girth can be divided into two groups:

non-surgical treatments

surgical treatments.

Non-surgical treatment

From ancient times, men have tried a wide variety of treatments to enlarge the penis. Because of the sensitive nature of the problem, and because of the surrounding shame and embarrassment, concerned men are very vulnerable to exploitation by the unscrupulous.

While most doctors and other healthcare professionals act in a highly ethical manner, a few individuals will sell remedies and even perform surgery that they know has no evidence of long-term benefit.

Some of them have been barred from practice as a consequence of their unethical behaviour.

Others are still in practice, waiting to exploit the unsuspecting by relying on the fact the patients are likely to be too embarrassed to complain to the authorities about an unsatisfactory outcome.

A glance though the small ads in men's magazines will reveal the following 'treatments' on offer:

Good-quality research evidence has not been published showing that any of these treatments produce a sustained increase in penis size.

Vacuum devices and weights may produce very small, short-term increases in size, simply because the penis is elastic and can be stretched. However, like an elastic band, it snaps back with time.

More worrying are private clinics that advertise penile augmentation (enlargement) procedures, and make extravagant and misleading claims about their results. Surgery can be of benefit to a few men (particularly those with micropenis), but certainly not all of them.

Current cosmetic surgical procedures are largely unproven by research, unreliable in their benefits, and may carry the risk of serious complications. Urologists generally consider this type of surgery to be still experimental in nature, and not a standard procedure.2

So seek advice from a trusted doctor, such as your GP or your local urologist, about the nature and standards of the clinic and its operations before asking for a consultation.

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Surgical treatment

Since 1971, penile-lengthening surgery has sometimes been offered to men with severe shortening due to

congenital abnormalities (abnormalities present from birth such as micropenis)

surgery that has gone badly (for penile cancer or Peyronie's disease)

or trauma (accidental or deliberate amputation).

Cosmetic surgery to increase penile girth, or thickness, began in the USA in the late 1980s.

Techniques for cosmetic lengthening were first described in 1990. More than 20,000 men have had such surgery (largely in America) , but reliable information about results and complications have not been published in a peer-reviewed journal (a journal where the quality and content of the research is checked by independent experts). Given the number of operations performed, this fact is both astounding and worrying.

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Penile lengthening: the most common technique to lengthen the penis is to cut its suspensory ligament and then perform plastic surgery to provide additional skin to cover its new length.

The results are difficult to judge, as surgeons have not collected data in a systematic manner. The results of the only reliable study indicate that dividing the suspensory ligament alone results in an average increase of 0.5cm (around 0.25in) in length, while skin advancement increases the length gain to 1.6cm (around 0.75in).

These figures do not compare well with the claims made by some clinics. Some people, undoubtedly, do better than average, while others do worse.

The suspensory ligament does have a role, in that it helps keep the penis pointing upwards during erection. After it has been divided, that support is no longer present.

After surgery, some men find that they have gained a small increase in flaccid length, but the erect penis is about the same size and now points towards the floor!

Increasing penile girth (thickness): this treatment may be performed with a lengthening procedure or on its own. There are two techniques in common use:

injection of liposuctioned fat, from the abdominal wall or thighs, into the dartos fascia, under the skin of the penile shaft

placing grafts of dermis (a layer of tissue from under the skin surface that is well supplied with blood vessels) and fat from the groin or buttock area within the penile shaft.

The results following injection of liposuctioned fat can be deeply disappointing. Up to 90 per cent of the fat can disappear within a year. Grafts seem to do rather better, but there are no reliable published data on long-term results.

Complications following surgery

At least one person has died from bleeding after augmentation surgery. Apart from the risks of infection and bleeding, various other complications may occur.

After lengthening procedures, there may be 'scrotalisation' of the penis, in which the organ looks as though it's arising from the scrotum instead of from the abdominal wall.

'Dog-ears' at each end of the operation scar.

Sloughing of the skin used to increase penile length (the skin has a poor blood supply and therefore dies, leaving a deep, ulcerated area).

After fat injection, loss of girth due to fat reabsorption.

Nodule formation, if the implanted fat does not disappear uniformly. The penis can be left with a deformed appearance, with irregular fatty lumps all over it.

Conclusions

Some men are severely anxious about their penis size and are prevented from enjoying a normal life as a result. They may ask for surgery.

Men who are born with a genuinely small penis may benefit from surgical treatment, but the results are unpredictable. Without surgery, many will still be able to enjoy very satisfactory sexual relationships despite the small size of their penises.

Men who are dissatisfied with the appearance of their penises should think very carefully before requesting cosmetic surgery, especially if the size really falls within the normal range.

Using surgery to treat a psychological problem is fraught with risks. If surgery is the only way in which a man can regain his self-esteem and improve his self-image, he should seek advice from an experienced surgeon working in a reputable clinic.

Men should ask very carefully about the procedures that are offered, about the surgeon's results and about any possible complications. They would also be wise to ask another trusted medical adviser (like a GP) for an independent view – before spending large sums of money.

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